Comparison of traditional radiofrequency ablation and high-power short-duration ablation in the treatment of atrial tachyarrhythmias

Abstract

Atrial tachyarrhythmias are becoming more common in the population. The prevalence increases with age. Often, these arrhythmias lead to disability and reduced life expectancy (indirectly through strokes). Drug therapy of atrial tachyarrhythmias reduces symptoms but does not completely resolve issue of treatment. In this regard, surgical treatment (catheter ablation) is preferable. One of the methods of catheter ablation is ablation using radio frequency energy. The key parameters of radiofrequency catheter ablation are the energy delivered to the endocardium and the time of this energy delivery. According to the traditional method, it is customary to use energy of 30 Watts for 30 s at one point. This technique has a disadvantage – in 30 s the electrode can be displaced, and the application of energy has to be repeated. A new strategy was proposed – reducing the application time by increasing the energy to respond to the challenge of high probability of electrode displacement. The aim of this work was to determine the effectiveness of the рhigh-power short-duration protocol. Materials and methods. To carry out this work, we analyzed the surgical treatment of atrial fibrillation with the help of radiofrequency catheter ablation – isolation of the pulmonary veins. In patient group 1, ablation was performed using an irrigated ablation electrode with an energy of 30 Watts and an application time of 30 s, in group 2 – using the irrigated electrode with the energy of 70 Watts and the application time of 5 s. Ablations were performed under the control of radiography and electroanatomical mapping system. Full electrical isolation of the four pulmonary veins with confirmation of the entrance and exit block were considered as the criteria of efficiency. Results. When comparing the groups by the number of required application cycles during the procedure needed to achieve the clinical effect and time to the first recurrence in all positions of the electrode, group 2 showed a lower number of applications and shorter time to the first recurrence. Reducing the time to pulmonary vein isolation, the number of relapses and restarting the control time, as well as shortening the time spent on the need to rebuild the electroanatomical map have resulted in a significant decrease in the duration of the radiofrequency ablation procedure. Conclusions. The work has shown that the use of the new protocol is more effective and allows to achieve the criteria of success faster than the traditional technique; the number of the procedure complications was not higher compared to traditional methods. When using the ablation protocol with higher energy, a lower incidence of atrial fibrillation recurrence was recorded.

Keywords

• atrial flutter
• atrial fibrillation
• paroxysmal tachycardia
• reciprocating tachycardias